Systems and methods for repairing tissue

ABSTRACT

Devices and methods for anchoring tissue to bone are provided herein. In various embodiments, the tissue anchor systems and methods can provide a length of suture having terminal ends coupled to one another via a sliding knot so as to define a suture loop having an adjustable length. After passing a portion of the suture loop through a damaged tissue and coupling the suture loop to bone, the sliding knot can be advanced to shorten the suture loop in order to secure the tissue to bone.

FIELD OF USE

The present disclosure relates to devices and methods for repairingtissue, in particular to suture anchoring devices and methods foranchoring tissue to bone.

BACKGROUND

A variety of injuries and conditions require repair of soft tissuedamage, or reattachment of soft tissue to bone and/or surroundingtissue. For example, when otherwise healthy tissue has been torn awayfrom a bone, such as a shoulder rotator cuff tendon being partially orcompletely torn from a humerus (a rotator cuff tear), surgery is oftenrequired to reattach the tissue to the bone, to allow healing andreattachment to occur. A number of devices and methods have beendeveloped for performing these surgical repairs, some of the moresuccessful methods include the use of suture anchors, which typicallyinclude an anchor body having one or more suture attachment features,and a tissue or bone engaging feature for retaining the suture anchorwithin or adjacent to the tissue or bone. Depending on the specificinjury, one or more suture anchors connected to, or interconnected by,one or more segments of suture, is used to perform the repair.

Surgery can also be required when a tear occurs in the substance of asingle type of tissue, for example in the meniscus of the knee (ameniscal tear). One method of repairing such a tear is to stitch itclosed by passing a length of suture through the tissue and tying thesuture. Suture can also be used in conjunction with one or more sutureanchors to repair such tissue tears. Sutures can be fastened to sutureanchors and to tissue using knots tied by the surgeon during a repairprocedure. In minimally invasive procedures, however, the surgeon mustuse tools inserted through a small diameter cannula or access portal,which can make the knotting process difficult and tedious.

Accordingly, there remains a need for improved methods and devices forrepairing torn or damaged tissue, and in particular for methods anddevices suitable for arthroscopic repair of torn or otherwise damagedtissue using suture anchors.

SUMMARY

Systems and methods for repairing damaged tissue, and particularly foranchoring tissue to bone, are provided herein. As described below, thesystems and methods can utilize a suture having terminal ends coupled toone another by a sliding knot (e.g., a pre-formed knot) that can beadvanced by a surgeon to secure a tissue to a bone anchor. Varioussystems and methods in accord with the teachings herein can be effectiveto facilitate the surgical techniques for reattaching soft tissue tobone. One example of such a technique is the repair of shoulderinstability resulting from a damaged labrum.

Various aspects of methods for anchoring tissue to bone are disclosedherein. In a first aspect, the method includes utilizing a length ofsuture having terminal ends attached to one another by a sliding knot.The length of suture defines a loop having a first engagement memberslidably disposed thereon at a location remote from the sliding knot.The first engagement member and a first portion of the loop can beadvanced through tissue at a first location within a patient's body.With the first portion of the loop extending through the tissue, thefirst engagement member can be withdrawn to a position outside of thepatient's body. The method also includes coupling the first engagementmember to a bone anchor, for example, after withdrawing the firstengagement member. The bone anchor, with the first engagement membercoupled thereto, is implanted in bone. The method also includesadvancing the sliding knot along the suture and toward the tissue toanchor the tissue to bone.

In some aspects, the method can include, after advancing the slidingknot, cutting the terminal ends of the suture extending from the slidingknot. In various embodiments, the method can include tensioning thesuture. In some embodiments, the method can also include drilling a bonehole that is configured to receive the bone anchor therein.

In one aspect, the sliding knot and the first engagement member aredisposed on opposed sides of the tissue, for example, when the tissue issecured to the bone anchor. In some embodiments, the sliding knot andthe bone anchor are disposed on opposed sides of the tissue.

In various embodiments, the loop can have a second engagement memberslidably disposed thereon at a location between the first engagementmember and the sliding knot. In such an aspect, the method can include,for example, advancing the second engagement member and a second portionof the loop through the tissue at a second location within a patient'sbody adjacent to the first location, withdrawing the second engagementmember to a position outside of the patient's body with the secondportion of the loop extending through the tissue, and coupling thesecond engagement member to the bone anchor. In various embodiments, aportion of the loop between the first and second engagement members canbe disposed on an opposed side of the tissue from the first and secondengagement members after the first and second engagement members areadvanced through the tissue. In one aspect, the method can includeinserting each of the first and second engagement members into a needleprior to advancing the first and second engagement members throughtissue such that the engagement members can be advanced through tissueby inserting each needle through the tissue at a desired location.

The engagement members can have a variety of configurations and can becoupled to the bone anchor in a variety of manners. For example, each ofthe first and second engagement members can comprise opposed first andsecond surfaces and two bores extending therebetween. In one aspect, thefirst and second engagement members are coupled to the bone anchor bythreading a portion of suture extending from the first and secondengagement members through the bone anchor. For example, the first andsecond engagement members can be coupled to the bone anchor by threadingthe first and second engagement members through a lumen extending from aproximal end to a distal end of the bone anchor. By way of example, thesecond engagement member can be coupled to the bone anchor afterwithdrawing the first engagement member. In some embodiments, the secondengagement member is not advanced through the tissue prior to beingcoupled to the bone anchor.

In one aspect, the bone anchor can be implanted with the first andsecond engagement members disposed therein. Alternatively, the boneanchor can be implanted with the first and second engagement membersdisposed adjacent to the distal end of the bone anchor.

In one aspect, a method for anchoring tissue to bone is provided thatincludes utilizing a suture loop having terminal ends attached to oneanother by a sliding knot and advancing a first segment of the loopthrough tissue at a first location within a patient's body. The methodalso includes withdrawing a portion of the first segment of the loop toa position outside of the patient's body with the first segment of theloop extending through the tissue. The first segment of the loop iscoupled to a bone anchor, for example, after withdrawing the firstsegment of the loop. The method also includes coupling a second segmentof the loop to the bone anchor and implanting the bone anchor, with thefirst and second segments coupled thereto, in bone. The sliding knot isadvanced toward the tissue to shorten the suture loop.

In various embodiments, the first and second segments can be coupled tothe bone anchor by threading the first and second segments through thebone anchor.

These and other aspects of the presently disclosed methods and systemsare detailed below.

BRIEF DESCRIPTION OF THE DRAWINGS

The presently disclosed embodiments will be more fully understood fromthe following detailed description taken in conjunction with theaccompanying drawings, in which:

FIG. 1 is a perspective view of an exemplary embodiment of a tissueanchor system in accord with the teachings herein;

FIG. 2 is a perspective view of the tissue anchor system of FIG. 1coupled to an exemplary bone anchor disposed within a bone hole;

FIG. 3 is a cross-sectional view of another exemplary embodiment of abone anchor;

FIG. 4A is a representation of a first engagement member of the tissueanchor system of FIG. 1 being delivered to a surgical site in a shoulderjoint;

FIG. 4B is a representation of a second engagement member of the tissueanchor system of FIG. 1 being delivered to the surgical site;

FIG. 4C is a representation of the first and second engagement membersof the tissue anchor system of FIG. 1 being withdrawn to a locationoutside the body;

FIG. 4D is a partial cross-sectional representation of the first andsecond engagement members of the tissue anchor system of FIG. 1 beingcoupled to the anchor member of FIG. 2;

FIG. 4E is a partial cross-sectional representation of the bone anchorof FIG. 2 disposed in a bone hole and with the tissue anchor system ofFIG. 1 secured thereto;

FIG. 5 is a cross-sectional view of an exemplary embodiment of a boneanchor.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the systems and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the systems andmethods described herein and illustrated in the accompanying drawingsare non-limiting exemplary embodiments and that the scope of the presentdisclosure is defined solely by the claims. The features illustrated ordescribed in connection with one exemplary embodiment may be combinedwith the features of other embodiments. Such modifications andvariations are intended to be included within the scope of the presentdisclosure.

Devices and methods for repairing torn or damaged tissue are providedherein. Various aspects of devices and methods in accord with thepresent teachings can enable a surgeon to quickly and consistentlyrepair tissue separations (e.g., the detachment of a labrum from theglenoid rim), while reducing the time spent tying complex surgical knotswithin the limited confines typical of arthroscopic procedures. It is tobe understood that particular devices and methods disclosed herein areexemplary and not limiting of the present invention. For example,embodiments illustrated for reattaching a detached or torn tendon orligament to bone can be similarly applied for repairing in-substanceinjuries to soft tissue, such as the meniscus of the knee, and thelabrum of the hip joint.

Tissue anchor systems and methods in accord with the present teachingsgenerally utilize a length of suture having terminal ends coupled to oneanother so as to define a suture loop having an adjustable length. Afterpassing a portion of the suture loop through a damaged tissue (e.g., adetached labrum) and coupling the suture loop to bone (e.g., theglenoid), the suture loop can be shortened to reattach the damagedtissue.

Referring now to the figures, an exemplary embodiment of a tissue anchorsystem 10 in accord with the present teachings is shown in FIG. 1. Thetissue anchor system 10 generally includes a length of suture 12 havingterminal ends 12 a,b coupled to one another by a sliding knot 14 so asto define a suture loop 16 having an adjustable length. In the exemplaryembodiment depicted in FIG. 1, the tissue anchor system 10 canadditionally include one or more engagement members 30 a,b slidablycoupled to the suture loop 16. As shown in FIG. 2, the engagementmembers 30 a,b can be coupled to a bone anchor 20 fixed within a bonetunnel 6, for example, so as to couple the tissue anchor system 10 tobone 2. The sliding knot 14 can be advanced to shorten the suture loop16, thereby fixing the tissue 4 to bone 2.

Though generally referred to as a “suture” herein, the suture 12 cancomprise any elongate element suitable for implantation and use inmaking surgical repairs. A person skilled in the art will appreciatethat the suture 12 can be formed from a variety of materials. By way ofexample, sutures for use in accord with the present teachings can befabricated from natural materials (e.g., silk) and/or syntheticmaterials, such as polypropylene, polyethylene terephthalate (PET) orother polyester materials. Moreover, the suture material can be selectedsuch that the suture 12 is absorbable (e.g., Panacryl® and Vicryl®, bothmanufactured by Ethicon, Inc., a Johnson and Johnson company) ornon-absorbable (e.g., Ethibond®, also manufactured by Ethicon, Inc.). Apartially absorbable suture for use with the systems and methodsdisclosed herein can include both a non-absorbable component (e.g.,polyethylene) and an absorbable component (e.g., polydioxanone), forexample. As will be appreciated by a person skilled in the art, suturesfor use in accord with the teachings herein can have any cross-sectionalshape, for example, a circular or non-circular cross-section, or anysize, for example, a #2 suture or other suture of larger or smallerdiameter.

In various embodiments, the terminal ends 12 a,b of the suture 12 can becoupled to one another so as to define a suture loop 16. As will bediscussed in detail below, a first terminal end 12 a of the suture 12can serve as a free end that can be actuated to tension the suture 12,while the second terminal end 12 b can be movably coupled to a portionof the suture 12 so as to define a suture loop 16.

While a variety of techniques can be used to movably couple the terminalends 12 a,b of the suture 12, in an exemplary embodiment a sliding knotis provided to enable the suture loop 16 to be shortened and/or thesuture 12 to be tensioned, for example, by pulling on at least one ofthe terminal ends 12 a,b. By way of example, the knot 14 can bevirtually any type of locking or non-locking sliding knot. As will beappreciated by a person skilled in the art, non-locking sliding knots(e.g., the Duncan loop, Tennessee Slider, and Roeder knot) can betensioned and subsequently locked to prevent slipping. By way ofexample, one or more additional loops can be thrown on top of thesliding knot 14 after the tissue has been positioned and the desiredtension is placed on the suture 12. A locking sliding knot (e.g.,Midshipman's Hitch and the Weston knot) can also be used in accord withthe methods and systems described herein. By way of example, a lockingsliding knot can be locked following proper tensioning of the suture byselectively applying tension in an appropriate sequence to the terminalends 12 a,b of the suture 12. Regardless of the technique used to couplethe first and second terminal ends 12 a,b, at least one of the terminalends can extend from the knot 14 to form a trailing end that can be usedfor applying tension to the suture 12 and/or decreasing the length ofthe suture loop 16.

The tissue anchor system 10 can be secured to bone using a variety ofdevices and techniques. By way of example, the suture 12 can be coupledto a bone anchor that is implanted at a selected surgical reattachmentsite. Bone anchors for use with the tissue anchor systems and methodsdisclosed herein are generally configured to securely engage bone so asto provide a point of attachment for the tissue anchor system 10 and canhave any number of configurations. As will be appreciated by a personskilled in the art, a variety of prior art bone anchors modified inlight of the teachings herein can be used to secure the tissue anchorsystem to bone. As will be discussed in detail below, in variousembodiments, the suture loop 16 can be coupled directly to a boneanchor, or in the alternative, can be indirectly coupled to a boneanchor via the coupling of the suture with an engagement member, whichin turn can be coupled to the bone anchor.

With reference now to FIG. 2, an exemplary embodiment of a bone anchor20 is depicted in a bone tunnel 6. As shown in FIG. 2, the bone anchor20 can have a generally cylindrical elongate body 22 extending between aproximal end 20 a and a tapered distal end 20 b that can facilitateentry into the bone tunnel 6. A lumen 24 can extend between the proximaland distal ends 20 a,b. In various aspects discussed in detail below,the lumen 24 can be configured to receive a portion of the suture loop16 and/or engagement members 30 a,b.

In various embodiments, the bone anchor 20 can additionally include oneor more bone-engaging features that can aid in securing the bone anchor20 to bone (e.g., within a bone tunnel). As will be appreciated by aperson skilled in the art, various bone-engaging features can beutilized, including, for example, barbs, teeth, threads, protrusions,etc. As depicted in FIG. 2, for example, the bone anchor 20 can includea plurality of ridges 26 formed on its external surface. As will beappreciated by a person skilled in the art, the ridges 26 can allow thebone anchor 20 to be forced distally (e.g., pushed) into the bone tunnel6, for example, and can prevent the bone anchor 20 from backing out ofthe bone.

Bone anchors for use in systems and methods described herein can alsohave a variety of configurations, shapes, and sizes, and can be formedfrom a variety of materials. By way of example, the bone anchor 20 canbe configured to be implanted within a bone tunnel 6, and can have asize and shape that allows it to be fully engaged with the bone tunnelwall through the thickness of the cortical bone at the implantationsite. As will be appreciated by a person skilled in the art, theproximal end 20 a of the anchor 20 can include features that enableengagement with a deployment device (e.g., driver) for implanting thebone anchor 20 into bone. Moreover, the physical properties of thematerial of which the bone anchor is formed can be sufficient to allowthe bone anchor to be driven or screwed into the bone tunnel 6, forexample, without damaging the bone anchor 20. Likewise, the material canhave sufficient strength so as to resist pull out, for example, whenproximal tension is applied to the bone anchor 20 or a suture coupledthereto. As will be appreciated by a person skilled in the art, boneanchors 20 for use in accord with the teachings herein can bebioabsorbable and/or osteoconductive such that the bone anchor 20 canpromote healing and/or ingrowth of native tissue.

In various embodiments disclosed herein, the suture 12 can be coupleddirectly to a bone anchor 20, or alternatively, can be indirectlycoupled to a bone anchor 20 via the coupling of the suture with anengagement member, which in turn, can be coupled to the bone anchor 20.For example, with reference now to FIG. 3, there is depicted anexemplary embodiment of a bone anchor 320 having a suture-engagingelement configured to engage a suture loop 316 directly. As will beappreciated by the person skilled in the art, suture-engaging elementscan be adapted to engage one or more suture loops 316 that extendthrough the inner lumen 324 of the suture anchor 320 and can have avariety of configurations.

As shown in FIG. 3, for example, the bone anchor 320 can include asuture-engaging post 326 extending from a sidewall of the lumen 324. Theangular orientation of the post 326 relative to a longitudinal axis ofthe bone anchor can vary, but in an exemplary embodiment the post 326can extend from the sidewall towards the distal end 320 b of the boneanchor 320. In such a manner, proximal tension on a suture loop 316extending distally beyond the post 326 can be effective to pull thesuture loop 316 within a suture-receiving cavity 328 between the post326 and the sidewall of the lumen 324.

Though the suture-engaging post 326 is depicted as being positionedadjacent to the distal end 320 b of the bone anchor 320, asuture-engaging element can be positioned at any position along thelength of the bone anchor 320 that is effective to couple a suture loop316 to the bone anchor 320. A person skilled in the art will furtherappreciate that the suture-engaging element can be integrally formedwith the bone anchor 320 (i.e., the bone anchor 320 and thesuture-engaging element can be molded as a single unit or formed from asingle piece of material), or the suture-engaging element can be fixedlyor removably mated to the bone anchor 320. One skilled in the art willappreciate that the anchor 320 can have features other than lumen 324 orsuture-engaging post 326 to couple to a suture. For example, atransverse bore (not shown) can be formed in the bone anchor 320 toreceive a suture.

As mentioned above, the suture can be coupled indirectly to a boneanchor. In various embodiments disclosed herein, the suture 12 can beindirectly coupled to a bone anchor via the coupling of the suture withan engagement member, which in turn, can be coupled to the bone anchor.As will be appreciated by a person skilled in the art, the engagementmember(s) are generally configured to be coupled to both a suture and abone anchor and can have a variety of configuration and.

With reference again to the exemplary tissue anchor system 10 depictedin FIG. 1, one or more engagement member(s) can be coupled to the sutureloop 16. As shown in FIG. 1, the engagement members can comprise tabs 30a,b having a generally elongate body. One or more bores 32 a,bconfigured to receive a tissue therethrough can extend between opposedfirst and second surfaces 34 a,b of the tabs 30 a,b.

The bores 32 a,b can be configured to slidably receive a suturetherethrough and can have a variety of configurations, sizes, andshapes. As will be appreciated by those skilled in the art, the bores 32a,b can be of any shape (e.g., circular, oval, etc.) and/or diametercapable of receiving a suture therein. As depicted in FIG. 1, forexample, the junction of the opposed surfaces 34 a,b and the bores 32a,b can be rounded so as to optimize the slidability of the suture 12therethrough and among the respective openings. In some embodiments, thebores 32 a,b can be angularly oriented relative to the opposed faces 34a,b so as to promote, for example, the angular displacement of a suturedisposed therethrough. In such a manner, a suture 12 traversing thefirst bore 32 a, for example, can be angularly guided toward the secondbore 32 b so as to reduce the profile of the suture 12 extending fromthe bores 32 a,b and/or prevent kinking of the suture 12.

Though the tabs 30 a,b appear identical in the exemplary embodimentdepicted in FIG. 1, a person skilled in the art will appreciate that anynumber of engagement members having similar or different configurationsfrom one another can be coupled to the suture loop 16. Similarly, anynumber of bores 32 a,b having the same or different configurations fromone another can extend through the tabs 30 a,b. For example, each of thebores 32 a,b can be substantially similar in shape (as shown) or theycan each have a distinct shape and/or diameter.

The tabs 30 a,b can have various features to enable coupling with thebone anchor 20. For example, with reference now to FIG. 2, the tabs 30a,b can be dimensioned so as to allow for their passage through thelumen of the bone anchor 20 in a first orientation. By way ofnon-limiting example, the tabs 30 a,b can have a length in a range fromabout 1.5 mm to about 6 mm, a depth (i.e., the distance between opposedsurfaces 34 a,b) less than about 3 mm, and a width less than about 3 mm.After being threaded distally through the lumen 24 and exiting thedistal end of the bone anchor 20, the tabs 30 a,b can be rotated to asecond orientation such that tension applied to a suture loop 16 coupledto the tabs 30 a,b can draw the tabs 30 a,b proximally into abutmentwith the distal end 20 b of the bone anchor 20, as shown in FIG. 2,thereby preventing further proximal movement. In some embodiments, forexample, the major dimension (e.g., length) of the tabs 30 a,b can beoriented perpendicular to the bone anchor 20 and the axis of the bonehole 6 in the second orientation, and the tabs 30 a,b can have a lengthequal to or less than the diameter of the bone hole.

Alternatively, in some embodiments, the bone anchor 20 can be configuredto retain the tabs 30 a,b within the lumen 24, rather than adjacent itsdistal end 20 b. For example, with reference now to FIG. 5, an exemplaryembodiment of a bone anchor configured to retain the tabs 30 a,b thereinis shown. The bone anchor 20 is substantially similar to that discussedabove in reference to FIG. 2, but differs in that a shoulder 26 can beformed within the lumen 24 such that the diameter of the lumen 24 at itsproximal end is smaller than that of its distal end. The relativedimensions of the lumen 24 and tabs 30 a,b can ensure that only one ofthe tabs 30 a,b can be passed through the proximal portion of the lumen24 at a time, whereas the distal portion of the lumen 24 can accommodateboth tabs 30 a,b therein in a side-by-side manner. Accordingly, the tabs30 a,b can be loaded into the bone anchor 20 sequentially, andsubsequently positioned side-by-side such the shoulder 26 can preventeither from being pulled out of the bone anchor 20, for example, by aproximal tension placed on the suture loop 16. By way of non-limitingexample, the tabs 30 a,b can have a length less than a length of thebone anchor 20 (e.g., 1 mm less than the length of the bone anchor 20)and a width and depth less than about 3 mm.

The present invention also provides methods for anchoring tissue tobone. FIGS. 4A-4E illustrate one exemplary method for anchoring tissueto bone in accordance with various aspects of the teachings herein.While virtually any tissue anchor system can be used to perform thetechniques described herein, FIGS. 4A-4E illustrate the use of theabove-described tissue anchor system 10 depicted in FIG. 1 forreattaching a detached labrum 4 to the glenoid 2 in the shoulder. Aperson skilled in the art will appreciate, however, that the tissueanchor systems and methods disclosed herein can be used for a variety ofsurgical procedures involving the reattachment of soft tissue. Oneskilled in the art will also appreciate that the system of the inventioncan be used with known and accepted arthroscopic surgical techniques,including patient preparation, anesthetization, and creation of one ormore portals through a patient's skin. By way of example, a surgeon canselect a location for reattachment of a detached labrum 4 to the glenoid2 and the selected site can be prepared, for example, by drilling intothe glenoid 2 a bone hole 6 for receiving a bone anchor 20.

One skilled in the art will appreciate that the methods disclosed hereinare typically performed in an arthroscopic procedure in which thevariety of instruments are passed through one or more cannulas or otheraccess ports. While FIGS. 4a -4E illustrate various steps of anexemplary procedure, they do so without illustrating a cannula or otheraccess port so as to provide more clarity to the illustration.

As otherwise discussed herein, a tissue anchor system 10 can be providedhaving a length of suture 12 having terminal ends 12 a,b coupled to oneanother by a sliding knot 14 so as to define a suture loop 16. One ormore engagement members 30 a,b can be slidably coupled to the sutureloop 16 and can be separated from one another and from the knot 14 by aportion of the suture loop 16, as depicted for example in FIG. 1. Insome embodiments, the suture anchor system 10 can be delivered to thesurgeon, for example, with the knot having been pre-tied.

Referring now to FIG. 4A, each of the tabs 30 a,b and a portion of thesuture loop 16 can be loaded into a delivery device configured todeliver the engagement members 30 a,b into the body (e.g., through skinsurface 8) and through the labrum 4. As will be appreciated by a personskilled in the art, the delivery device can comprise, for example, aneedle 9 having a passageway that can slidably receive a tab 30 a,b. Theneedle 9 can be inserted into the patient and through the labrum 4 toadvance the tab 30 a and a portion of the suture loop 16 a through thelabrum 4 at a desired location. The needle 9 can also include, forexample, a trigger mechanism (not shown) that can selectively eject thetab 30 a from the needle 9. In some embodiments, the sliding knot 14 canremain outside the body while advancing the tab 30 a through the labrum4.

In one exemplary embodiment, a second needle 9′ can then be insertedinto the patient through the same or different incision in the skinsurface 8 and through the labrum 4 at a location adjacent to the firstlocation to advance the tab 30 b and a second portion of the suture loop16 b through the labrum 4, as shown in FIG. 4B, for example. With bothtabs 30 a,b advanced through the labrum 4, a portion of the suture loop16 c between the tabs 30 a,b can remain disposed on the opposite side ofthe labrum 4 from the tabs 30 a,b, for example, outside the body. Insome embodiments, the sliding knot 14 can remain outside the body whileadvancing the tab 30 b through the labrum 4.

After advancing the tabs 30 a,b through the labrum 4, the tabs 30 a,bcan be withdrawn from the body with each portion of the suture loop 16a,b extending through the labrum 4, as shown in FIG. 4C. The tabs 30 a,bcan then be removed from the joint and withdrawn from the body throughthe same or different incision(s) in the skin surface 8 which theneedles 9, 9′ were originally inserted through the skin surface 8. Byway of example, a grasper (not shown) can be inserted into the body towithdraw the tabs 30 a,b to a location outside the body. As shown inFIG. 4C, in some embodiments the tabs 30 a,b can be removed from thebody without re-penetrating the labrum 4. For example, the tabs 30 a,bcan be withdrawn around a side of the tissue to be re-attached, ratherthan through it.

As shown in FIG. 4D, after withdrawing the tabs 30 a,b to a locationoutside the body, the tabs 30 a,b can be coupled to a bone anchor 20 ina manner previously discussed herein. By way of example, the tabs 30 a,bcan threaded through a lumen of the bone anchor 20. In some embodiments,the portion of the suture loop 16 c extending between the first andsecond tabs 30 a,b can be threaded through the bone anchor 20. With thetabs 30 a,b coupled to the bone anchor (e.g., at its distal end 20 b),the bone anchor 20 can be reinserted into the body and implanted intothe bone tunnel 6. Alternatively, as discussed above, the bone anchor 20can be reinserted into the body and implanted into the bone tunnel 6with the tabs 30 a,b disposed therein (e.g., within the lumen 24 asdiscussed above in reference to FIG. 5).

By way example, the bone anchor 20 can be inserted into the bone tunnel6 without penetrating the labrum 4. For example, the bone anchor 20 canbe advanced beyond the labrum 4 and into the bone tunnel 6 on the sameside of the tissue 4 around which the tabs 30 a,b, were withdrawn, inaccord with some embodiments as discussed above. After implantation ofthe bone anchor 20, the sliding knot 14 can be advanced along the sutureand toward the labrum 4 to anchor the labrum 4 to the glenoid 2, asshown in FIG. 4E. By way of example, advancing the sliding knot can beeffective to shorten the length of the suture loop 16. In variousembodiments, the suture 12 can be tensioned until the labrum 4 isre-approximated in its desired position. Once the suture 12 has beentensioned, for example, the terminal ends 12 a,b of the suture 12extending from the sliding knot 14 can be cut.

As will be appreciated by a person skilled in the art, theabove-described exemplary technique can result, for example, in thesliding knot 14 being disposed on an opposed side of the labrum 4 fromthe tabs 30 a,b and the bone anchor 20 when the labrum 4 is reattachedto the glenoid 2. It should be further appreciated that theabove-described exemplary technique can result in a “mattress stitch,”in which a portion of the suture loop 16 c can extend from a first tab30 a to an internal surface of the labrum 4 (i.e., on the surface of thelabrum 4 adjacent the glenoid 2), through the labrum 4 to an externalsurface thereof, back through the labrum 4 at an adjacent location toemerge from the labrum's internal surface, and to a second tab 30 b.

It will also be appreciated that devices and methods in accord with theteaching herein can be effective to apply, for example, a “simplestitch” to anchor the labrum 4 to the glenoid 2. In such a technique,the tab 30 a can be advanced through the labrum 4, withdrawn to alocation outside the body, and coupled to the anchor 20, substantiallyas described above with reference to FIGS. 4A-4D. The technique differsin that the second tab 30 b can be coupled to the bone anchor 20 andsubsequently implanted in the bone tunnel 6 without being advancedthrough the labrum 4. As such, a portion of the suture loop 16 c canextend from a first tab 30 a to an internal surface of the labrum 4,through the labrum 4 to an external surface thereof, around an edge ofthe labrum 4, and to a second tab 30 b.

The exemplary method described above with reference to FIGS. 4A-4E isbut one exemplary method in accord with the present teachings. As willbe appreciated by a person skilled in the art, the order of the varioussteps can be altered, and more or fewer steps than those described canbe used to anchor tissue to bone. For example, though FIG. 4D depictsthe coupling of the tabs 30 a,b to the bone anchor 20 after the tabs 30a,b are withdrawn from the body, in some embodiments, the tabs 30 a,bcan be coupled to the bone anchor 20 before being withdrawn from thebody or can remain in the body after passing through the tissue 4 andcan be coupled to the bone anchor 20 after the bone anchor has beenimplanted in a bone hole 6.

Though the exemplary method illustrated in FIGS. 4A-4E depict the tissueanchor system 10 being coupled to the bone anchor 20 via engagementbetween the tabs 30 a,b and the bone anchor 20, the exemplary methoddescribed above can also be performed by directly delivering throughtissue portions of the suture loop without an engagement member coupledthereto. For example, as described above with reference to FIG. 3, thebone anchor 320 can include a suture-engaging element (e.g., post 326)that can directly engage the suture. Accordingly, in such an embodiment,segments of the suture loop 316 can be advanced through tissue,retrieved (e.g., withdrawn outside the body), and coupled directly tothe bone anchor 320, as otherwise discussed herein.

A person skilled in the art will further appreciate that the tissueanchor systems described herein can have a variety of otherconfigurations, and that a variety of other techniques can be used tore-approximate torn or damaged tissue. Moreover, while theabove-described system and methods are described as having only one boneanchor (e.g., a single re-attachment point), the systems and methodsdescribed herein can be used with any number of bone anchors. In such amanner, the same or different lengths of suture can be used to couple tomultiple bone anchors.

One skilled in the art will appreciate further features and advantagesof the presently disclosed method and system based on theabove-described embodiments. Accordingly, the present disclosure is notto be limited by what has been particularly shown and described, exceptas indicated by the appended claims. All publications and referencescited herein are expressly incorporated herein by reference in theirentirety.

What is claimed is:
 1. A method for anchoring tissue to bone,comprising: utilizing a length of suture having terminal ends attachedto one another by a sliding knot, the length of suture defining a loophaving a first engagement member slidably disposed thereon at a locationremote from the sliding knot and a second engagement member slidablydisposed thereon at a location between the first engagement member andthe sliding knot; advancing the first engagement member and a firstportion of the loop through tissue at a first location within apatient's body; withdrawing the first engagement member to a positionoutside of the patient's body with the first portion of the loopextending through the tissue; coupling the first engagement member to abone anchor; implanting the bone anchor, with the first engagementmember coupled thereto, in bone; advancing the sliding knot along thesuture and toward the tissue to anchor the tissue to bone; engaging atleast one of the first and second engagement members against a surfaceof the bone anchor; and engaging the first engagement member against asurface of the second engagement member.
 2. The method of claim 1,wherein the sliding knot and the first engagement member are disposed onopposed sides of the tissue.
 3. The method of claim 1, wherein thesliding knot and bone anchor are disposed on opposed sides of thetissue.
 4. The method of claim 1, further comprising: advancing thesecond engagement member and a second portion of the loop through thetissue at a second location within a patient's body adjacent to thefirst location; withdrawing the second engagement member to a positionoutside of the patient's body with the second portion of the loopextending through the tissue.
 5. The method of claim 4, wherein aportion of the loop between the first and second engagement members isdisposed on an opposed side of the tissue from the first and secondengagement members after advancing the first and second engagementmembers through the tissue.
 6. The method of claim 4, furthercomprising, prior to advancing the first and second engagement membersthrough tissue, inserting each of the first and second engagementmembers into a needle, and wherein advancing the first and secondengagement members through tissue comprises inserting each needlethrough the tissue at a desired location within the tissue.
 7. Themethod of claim 4, wherein coupling the first and second engagementmembers to the bone anchor comprises threading a portion of sutureextending from the first and second engagement members through the boneanchor.
 8. The method of claim 4, wherein coupling the first and secondengagement members to the bone anchor comprises threading the first andsecond engagement members through a lumen extending from a proximal endto a distal end of the bone anchor.
 9. The method of claim 4, whereinthe bone anchor is implanted with the first and second engagementmembers disposed therein.
 10. The method of claim 4, wherein the boneanchor is implanted with the first and second engagement membersdisposed adjacent to the distal end of the bone anchor.
 11. The methodof claim 1, further comprising coupling the second engagement member tothe bone anchor after withdrawing the first engagement member.
 12. Themethod of claim 11, wherein the second engagement member is not advancedthrough the tissue prior to being coupled to the bone anchor.
 13. Themethod of claim 1, further comprising, after advancing, cutting theterminal ends of the suture extending from the sliding knot.
 14. Themethod of claim 1, further comprising tensioning the suture.
 15. Themethod of claim 1, further comprising drilling a bone hole configured toreceive the bone anchor therein.
 16. The method of claim 1, wherein eachof the first and second engagement members comprise opposed first andsecond surfaces and two bores extending therebetween.
 17. The method ofclaim 1, wherein the coupling step is performed outside of the patient'sbody.
 18. A method for anchoring tissue to bone, comprising: utilizing alength of suture having terminal ends attached to one another by asliding knot, the length of suture defining a loop having a firstengagement member slidably disposed thereon at a location remote fromthe sliding knot and a second engagement member slidably disposedthereon at a location between the first engagement member and thesliding knot; advancing the first engagement member and a first portionof the loop through tissue at a first location within a patient's body;withdrawing the first engagement member to a position outside of thepatient's body with the first portion of the loop extending through thetissue; coupling the first engagement member to a bone anchor bythreading a portion of suture extending from the first engagement memberthrough a lumen extending from a proximal end to a distal end of thebone anchor; implanting the bone anchor, with the first engagementmember coupled thereto, in bone; advancing the sliding knot along thesuture and toward the tissue to anchor the tissue to bone; engaging atleast one of the first and second engagement members against a surfaceof the bone anchor; and engaging the first engagement member against asurface of the second engagement member.
 19. The method of claim 18,wherein coupling the first engagement member to a bone anchor furthercomprises placing the first engagement member in contact with the distalend of the bone anchor.
 20. The method of claim 18, wherein the slidingknot and the first engagement member are disposed on opposed sides ofthe tissue.
 21. The method of claim 18, wherein the coupling step isperformed outside of the patient's body.